Allergy & Immunology Value-Based Care Software

Value-Based Care in a Allergy & Immunology Practice

For most allergy practices, value-based care starts with MIPS. Quality ID 398, Optimal Asthma Control, is an outcome measure for patients aged 5 to 50 with asthma. A patient meets it only when two things are true. The latest control score is in range, and asthma emergency visits plus inpatient stays add up to fewer than two over the prior year. Unlimited Systems puts the fields for both parts into the visit. A patient booked for an asthma follow-up with no recent score is flagged at scheduling, so the score is collected at check-in. Event counts are asked and saved in the same place each time. Exclusions such as COPD or hospice are recorded when they apply. Practices in commercial asthma contracts or ACOs can also track shared-savings and downside terms in the general ledger. That way contract results are watched during the year, not found out after it ends.

Why Is Value-Based Care Different in Allergy & Immunology?

Asthma quality is measured by outcomes, not just by whether a test was done. Measure 398 asks whether the patient's asthma is controlled and whether they avoided repeat emergency visits and hospital stays. Both answers come from the patient. If staff do not ask at each visit, the practice cannot show the good care it actually gave.

The scoring tools differ by age. Measure 398 accepts the ACT for ages 12 and up, the C-ACT for ages 11 and under, the ACQ for ages 17 and up, and the ATAQ for children and adults. Each has its own cut point, such as an ACT of 20 or more. Value-based care in an allergy practice has to record the right tool and score for each patient, or the measure counts as not met.

Programs also change. ACAAI reports that CMS has not yet set up an allergy-specific MIPS Value Pathway, so allergists choose measures under traditional MIPS. CMS also removed three measures from the allergy and immunology specialty set for 2026. A practice needs to see which measures it is reporting and how each one is trending before the performance year closes.

What Allergy & Immunology Value-Based Care Software Handles

MIPS Quality ID 398 numerator

A patient meets the measure only when the latest control score is in range and asthma ED visits plus inpatient stays total fewer than two over the prior year. Both values are captured at the visit. (CMS QPP 2026 MIPS CQM Specification, Quality ID 398: Optimal Asthma Control)

Asthma control tools and cut points

ACT and C-ACT count as well controlled at 20 or more, ACQ at 0.75 or less, and ATAQ at 0. The visit records which tool was used, so the score is read against the right cut point. (CMS QPP 2026 MIPS CQM Specification, Quality ID 398: Optimal Asthma Control)

Measure 398 denominator and exclusions

The denominator uses asthma codes J45.20 through J45.998 with an established office or telehealth visit. COPD, emphysema, cystic fibrosis, acute respiratory failure, hospice and palliative care exclude a patient and are recorded when they apply. (CMS QPP 2026 MIPS CQM Specification, Quality ID 398: Optimal Asthma Control)

Allergy and immunology specialty measure set

For 2026, CMS removed screening for social drivers of health, connection to a community service provider and adult COVID-19 vaccination status from the set. The measures a practice picks are tracked side by side through the year. (ACAAI: 2026 MIPS Final Policies (allergy and immunology specialty set, MVP status, performance threshold))

MIPS performance threshold

CMS kept the performance threshold at 75 points through the 2028 performance period. Measure trends during the year show where the practice stands against it. (ACAAI: 2026 MIPS Final Policies (allergy and immunology specialty set, MVP status, performance threshold))

Shared Savings Program ACOs

When an allergy group takes part in a Medicare Shared Savings Program ACO, results depend on cost and quality across the ACO. Shared-savings and downside terms are tracked in the general ledger with the rest of the books. (CMS Medicare Shared Savings Program (ACOs))

How Does Allergy & Immunology Value-Based Care Software Work?

1. 1. Flag gaps at scheduling

   When an asthma patient is booked, the visit shows whether a current control score and event count are on file. Missing items are flagged before the patient arrives.

2. 2. Collect the score at check-in

   The patient completes the right tool for their age, such as the ACT or C-ACT. The score is saved to a structured field, not buried in a note, and forms can go out ahead through pre-visit intake.

3. 3. Ask about events

   Staff record asthma emergency visits and hospital stays since the last count. Patients with two or more show as at risk on the schedule.

4. 4. Audit before checkout

   Before the visit closes, the required quality fields get a final check. A missing score or exclusion can be fixed before the patient leaves.

5. 5. Track measures and contracts

   Measure 398 and other chosen measures are trended through the year. Contract terms for shared savings sit in the ledger, and trends feed allergy reporting.

Allergy & Immunology Value-Based Care Software vs. Generic Software

Who Uses It in a Allergy & Immunology Practice

• Front desk: A flag on asthma visits that need a control score, so the right form is handed over at check-in.
• Allergist: Control scores and event counts in one view at every visit, showing which patients may need a change in care.
• Practice owner: Measure trends and shared savings terms in one place, with drill-down through allergy analytics.